三线或后线治疗转移性结直肠癌 MSS 型患者。
Third- or Further-Line Treatment in Patients with MSS Type Metastatic Colorectal Cancer.
机构信息
Medical Oncology Department, The Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
The Eighth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
出版信息
J Gastrointest Cancer. 2024 Nov 18;56(1):21. doi: 10.1007/s12029-024-01120-9.
BACKGROUND
The survival benefit from later-line treatment for patients with metastatic colorectal cancer (mCRC) remains disappointing. Here, in a real-world study, we were aimed to evaluate which choice will affect the survival of mCRC patients after standard treatment in Chinese patients.
METHODS
A total of 129 patients with refractory mCRC were involved in the study. They received targeted monotherapy or combined with chemo-agents or PD-1 inhibitor before death. Overall survival (OS) and progression-free survival (PFS) were reviewed and evaluated from clinical features and treatment options.
RESULTS
Among the 129 patients, the median age was 56 years (25-81). The mOS from third-line was 12.5 months. OS of patients who treated with chemo plus targeted therapy group in third-line was shown to be superior to pd-1 inhibitor in combination with antiangiogenic agents or antiangiogenic monotherapy group (15.6 m vs. 10.5 m vs. 8.4 m, p < 0.05). Patients had received triplet-drugs (bevacizumab plus low-dose irinotecan and oxaliplatin) and had prolonged survival compared to those had not (21.3 m vs 10.3 m, p = 0.004). OS between patients who had immunotherapy history or not was not significantly different (p > 0.05). The mPFS was 3.5 months in patients who had administered with antiangiogenic targeted agents plus anti-pd-1 and 4.7 months in chemo plus targeted therapy group and 2.2 months in the other group. In the triplet drugs group, preliminary results showed that ORR was 13.3% and DCR was 80%. The median PFS was 5.1 m, and the median OS was 10.6 m.
CONCLUSIONS
Triplet drugs resulted in significantly longer overall survival, and immunotherapy may have limited benefit in MSS type CRC patients.
背景
转移性结直肠癌（mCRC）患者接受后线治疗的生存获益仍然令人失望。在此，我们通过一项真实世界研究旨在评估在中国患者中，标准治疗后哪种治疗选择会影响 mCRC 患者的生存。
方法
本研究共纳入 129 例难治性 mCRC 患者，在死亡前接受了靶向单药或联合化疗药物或 PD-1 抑制剂治疗。从临床特征和治疗方案回顾和评估总生存期（OS）和无进展生存期（PFS）。
结果
在 129 例患者中，中位年龄为 56 岁（25-81 岁）。三线治疗的 mOS 为 12.5 个月。三线治疗中接受化疗联合靶向治疗组的 OS 优于 PD-1 抑制剂联合抗血管生成药物或抗血管生成单药治疗组（15.6m vs. 10.5m vs. 8.4m，p<0.05）。接受三联药物（贝伐珠单抗联合低剂量伊立替康和奥沙利铂）治疗的患者与未接受三联药物治疗的患者相比，生存时间延长（21.3m vs. 10.3m，p=0.004）。有免疫治疗史与无免疫治疗史的患者 OS 无显著差异（p>0.05）。接受抗血管生成靶向药物联合抗 PD-1 治疗的患者 mPFS 为 3.5 个月，化疗联合靶向治疗组为 4.7 个月，其他组为 2.2 个月。在三联药物组中，初步结果显示 ORR 为 13.3%，DCR 为 80%。中位 PFS 为 5.1 个月，中位 OS 为 10.6 个月。
结论
三联药物可显著延长总生存期，免疫治疗可能对 MSS 型 CRC 患者获益有限。
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